Provider Demographics
NPI:1376896977
Name:REID, KRYSTEL DAWN
Entity Type:Individual
Prefix:
First Name:KRYSTEL
Middle Name:DAWN
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 COLLETON ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1133 COLLETON ST
Practice Address - Street 2:APARTMENT 2
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5322
Practice Address - Country:US
Practice Address - Phone:803-446-8981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker